COMPLEMENTARY THERAPIES

Complementary Therapies associated with Parkinson's disease

Acknowledgement

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

Abstract

Allied health care and complementary therapies are used by many patients with Parkinson's disease (PD). For allied health care, supportive scientific evidence is gradually beginning to emerge, and interventions are increasingly integrated in the treatment programs for PD patients. To evaluate whether such multidisciplinary programs are justifiable, we review the literature of allied health care and complementary therapies in PD. According to the level of available evidence, we provide recommendations for clinical practice. Finally, we discuss the need for an improved organization of allied health care, and identify topics for future research to further underpin the pros and cons of allied health care and complementary therapies in PD.

Table of contents

Acknowledgement2

Abstract3

Introduction5

Allied health care interventions7

Physiotherapy8

Gait8

Transfers9

Balance9

Body posture10

Reaching and grasping10

Physical inactivity10

Occupational therapy11

Speech therapy12

Speech and language disorders13

Swallowing14

Drooling14

Other allied health care interventions15

Dietician15

Social work16

Sexologist16

Tai Chi17

Qigong17

Massage18

Acupuncture18

Nutritional supplements18

Drawbacks to current allied health care21

Multidisciplinary treatment of PD22

Evidence for multidisciplinary care in PD (and beyond)24

Future trials26

Methods27

Study selection28

Data extraction, quality, and validity assessment28

Results29

Study quality35

Outcomes35

Discussion37

Conclusion38

References42

Complementary Therapies associated with Parkinson's disease

Introduction

The progressive nature and wide diversity of symptoms make Parkinson's disease (PD) a complex and challenging disorder for both patients and health care professionals, causing significant social and financial burden . To tackle these challenges, recent guidelines recommend that health professionals should consider approaching their patients using a comprehensive, multidisciplinary approach . The most effective intervention for PD is symptomatic drug treatment using levodopa, but a drawback is that long-term use leads to response complications such as dyskinesias. For a subgroup of well-selected patients, neurosurgery is a good alternative(Herman, 2007, pp. 1154).

But despite optimal medical management using drugs or surgery, patients continue to experience progressive deterioration of body functions, daily activities and participation. To treat these problems, allied health care interventions and complementary therapies are commonly engaged . Allied health occupations such as physiotherapy, occupational therapy and speech therapy aim to maximize the performance of daily activities and minimize secondary complications, mainly by using compensatory strategies . Estimates of current use of allied health care in PD are in the range of 7-57% for physiotherapy, 9-25% for occupational therapy and 4-20% for speech therapy . In addition, some 40-44% of patients in the USA and United Kingdom resort to complementary therapies, most commonly massage, vitamins, herbs and acupuncture . Despite this widespread use of allied health care interventions and complementary therapies in PD, various practical concerns remain, including the level of supporting evidence and the degree of specific expertise among professionals and practitioners delivering these interventions(Ernst 1997, p. 480).

This review aims to provide an overview of evidencebased allied health care interventions and complementary therapies in PD. For allied health interventions such as physiotherapy, occupational therapy and speech therapy, we will describe the 'core areas' (i.e. the specific disease domains where intervention is deemed to be useful). For each specific area the level of available evidence is ...